Characteristics and Associated Factors of Postoperative Pulmonary Complications in Patients Undergoing Radical Cystectomy for Bladder Cancer: A National Surgical Quality Improvement Program Study

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Abstract

Micro-Abstract

Data regarding postoperative pulmonary complications after radical cystectomy are still limited. By analyzing the National Surgical Quality Improvement Program database, our study showed that approximately 5.6% of patients undergoing radical cystectomy had at least one postoperative pulmonary complication. Several preoperative associated factors for postoperative pulmonary complications were identified and should be helpful for risk stratification, patient counseling, and perioperative care.

Introduction:

The purpose of this study was to summarize the characteristics and identify associated factors of postoperative pulmonary complications (PPCs) in patients undergoing radical cystectomy (RC).

Materials and Methods:

The National Surgical Quality Improvement Project (NSQIP) database (2005-2014) was used to identify patients who underwent RC for bladder cancer. PPCs were defined as pneumonia, unplanned reintubation, and ventilator support > 48 hours within 30 days of RC. Incidence, timing, and outcomes of PPCs were described and analyzed. Multivariable logistic regression was used to evaluate associated factors of PPCs.

Results:

Among 3790 patients included, 213 (5.6%) had at least 1 PPC. Patients with PPCs had a significantly higher 30-day mortality (17.4% vs. 0.7%; P < .001) and longer hospital stay (13 vs. 8 days; P < .001). Logistic regression showed that age ≥ 75 years (odds ratio [OR], 2.07; P = .001), body mass index < 18.5 kg/m2 (OR, 2.48; P = .017), body mass index ≥ 30 kg/m2 (OR, 1.71; P = .009), dependent functional status (OR, 2.77; P = .006), current smoker (OR, 1.57; P = .011), chronic obstructive pulmonary disease (OR, 1.70; P = .018), insulin-treated diabetes (OR, 1.70; P = .042), and albumin < 3.5 g/dL (OR, 1.72; P = .015) were associated with increased risk of overall PPCs.

Conclusion:

Approximately 5.6% of patients have at least one PPC within 30 days of RC. Several preoperative associated factors for PPCs were identified, which should be helpful for risk stratification, patient counseling, and perioperative care.

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